The back and forth tussle with Malaria

Depiction of common antimalarial medication. Photo taken from http://www.antimalariatablets.co.uk/malaria-overview/frequently-asked-questions-on-malaria-prevention-health-protection-agency/

Just to recap the past few posts, we have introduced certain concepts of malaria such as its biology and how it affects people. This post is no different. In the fight against malaria, knowledge is key and this is certainly the case for today’s topic: diagnosis and therapies.

The global effort of the World Health Organisation(WHO) and other Non-Governmental Organisations (NGOs) such as the Bill and Miranda Gates Foundation have aided to reduce malaria by 37% from 2010–2015. Despite a steep drop, in the WHO 2016 Global Report, in 2015, an estimated 212 000 000 individuals had contracted the disease.

Diagnosing and treating

To prevent lethal outcomes from malaria, proper case management through early diagnosis and high-quality antimalarial treatment is required. The diagnosis can either be done through a microscopy film or a rapid diagnosis tests (RDTs). The latter being able to diagnose an infection within thirty minutes. Currently, effective antimalarial treatments include artemisinin and the combination therapy. However, resistance to antimalarial drugs are something proving to be a future hindrance to the aim of eradication of the disease.

Resistance to antimalarials

Past resistance to previously used antimalarials such as chloroquine became widespread in the 1970s and 1980s. In particular, there are strains of Plasmodium Falciparum which are resistant to nearly all antimalarials current in use. In addition, resistance to artemisinin has been detected in the Greater Mekong Sub-region in South East Asia. The result is a long treatment process with combination therapies containing a partner drug. This development has gained the attention of various global health initiatives such as WHO. The concern is that resistance may spread to Indian and Sub-Saharan Africa, where 90% of the burden of malaria is centred.

So why the appearance of resistant strains? Artemisinin resistance in the GMS has been attributed to factors such as:

  • the widespread distribution of substandard, spurious, falsely-labelled, falsified and counterfeit (SSFFC) antimalarials
  • the misdiagnosis and subsequent dispensing of oral artemisinin monotherapies (oAMTs)

So what can we do?

It is important to understand that many of this issues require the help of governmental bodies. We need a call for better regulations in these affected countries. It is important to engage the public that may not fully understand the extent of malaria to understand the issues and provide a platform for advocacy. So do share this information with whomever you think might be interested in the issue.

In addition, do comment below, do you think that we are able to advocate for better drug regulations and access to higher quality medications in the affected countries? We would love to hear your opinions on the matter.

References:

  1. World Health Organisation. World Malaria Report 2015. Geneva; 2015.

2. Dondorp A, Newton P, Mayxay M, Damme V, Smithuis F, Yeung S, et al. Fake antimalarials in Southeast Asia are a major impediment to malaria control: multinational cross-sectional survey on the prevalence of fake antimalarials. Tropical Medicine and International Health. 2004;9(12):1241–1246.

3. Bell D. The Use of Malaria Rapid Diagnostic Tests. Geneva; 2004.

4. PB B. In: Drug Resistance in Malaria. 2001 World Health Organisation.

5. Nayyar GM, Breman JG, Newton PN, Herrington J. Poor-quality antimalarial drugs in southeast Asia and sub-Saharan Africa. Lancet Infect Dis. 2012 Jun;12(6):488–496.

6. Almuzaini T, Choonara I, Sammons H. Substandard and counterfeit medicines: a systematic review of the literature. BMJ Open. 2013;3(8).

7. World Health Organisation. In: Essential medicines: regulatory action needed to stop the sale of oral artemisinin based monotherapy. Issue 2, 2010 World Health Organisation.